Norfolk Community Virtual Wards

Inclusion criteria

• Over 18 who has been assessed to be living with frailty and is in a crisis that requires acute level care.
• An informed and capacious decision of the patient or carer/family member where appropriate, who wants to have their treatment at home.
• Where a person is living with dementia, this should not exclude admission to the Hospital at Home service.
• Expected required treatment time is short-term intervention of 1 to 14 days.

Exclusion Criteria

• Severe injury like non-ambulatory fractures requiring urgent orthopaedic opinion.
• Experiencing a mental health crisis and requires referral or assessment by a specialist.
  mental health team that cannot be supported in the community.
• Needs acute/complex diagnostics and/or clinical intervention that can only be offered in hospital.
• Patient does not want to be admitted.
• For safeguarding reasons, it is not safe for a person to remain in their home or usual place of residence.

Inclusion and exclusion criteria will vary between local systems and virtual wards, depending on what is available and how long services have been established.

Exclusion criteria

• Severe or life-threatening presentations of pneumonia, asthma or COPD – but remembering that patients may receive end of life care at home if that is their preferred place.
• Unstable or worsening clinical trajectory for example saturations more than 93% unless confirmed baseline and/or NEWS2 less than 5.
• Suspected sepsis.
• Chest pain that is concerning for a serious cause requiring immediate hospital transfer for example acute coronary syndrome.
• Pregnant women with saturations of more than 94%
• Where urgent oxygen is required in less than 4 hours of urgent delivery.

Inclusion criteria

• Over 18 years, needing acute level care.
• Can be safely and effectively managed in community.
• Current heart failure diagnosis confirmed by a heart failure specialist.
• High risk of deterioration or admission to hospital or could step down from heart failure admission for early supported discharge.
• Would otherwise remain in a secondary care bed.
• Discussed with and/or reviewed by a heart failure specialist at the time of onboarding.
• Referred by the heart failure multidisciplinary team (MDT).
• Can benefit from daily remote monitoring, regular clinical re-assessment and are suitable for remote treatment by a heart failure specialist team, including home visits where required.
• Have made an informed decision and consented to be on a virtual ward based on their needs and preferences, and carer support where appropriate at the patient’s best interest.
• Are expected to be in the service in the short term (usually managed within 14 days).

Exclusion Criteria

• Clinical presentations, co-morbidities or psychosocial problems which can only be investigated, treated, or care coordination that can only be achieved with a hospital admission. The definition of each of these exclusion criteria should be developed with HF specialists and be robustly considered by each ICB co-ordinating their own virtual ward programme.
• Acute pulmonary oedema should not be a reason for heart failure virtual ward admission unless supporting patients as part of an end-of-life care at home pathway.
• For safeguarding reasons, where it is not safe for a person to remain in their home or usual place of residence.